Provider Demographics
NPI:1811612138
Name:GUANZING, SHERYSSE JOSEL YNCHAUSTI (PT, DPT)
Entity type:Individual
Prefix:
First Name:SHERYSSE JOSEL
Middle Name:YNCHAUSTI
Last Name:GUANZING
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SHERYSSE JOSEL
Other - Middle Name:YNCHAUSTI
Other - Last Name:GUANZING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:80 BANKS AVE APT 2343
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3343
Mailing Address - Country:US
Mailing Address - Phone:929-733-8600
Mailing Address - Fax:
Practice Address - Street 1:80 BANKS AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3330
Practice Address - Country:US
Practice Address - Phone:929-733-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011958225200000X
NY044300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant